UC San Diego

Background: Although medical advancements have transformed the prognosis and increased the life expectancy of people living with HIV (PLHIV), the health-related quality of life (HRQOL) of these individuals remains suboptimal. Objectives: The aims of this dissertation are to: 1) assess the psychometric properties of Medical Outcome Survey-HIV (MOS-HIV), which is the most commonly used HRQOL measurement; 2) explore the multidimensional association of social support (emotional and instrumental) and HRQOL (physical and mental) among recently diagnosed PLHIV in rural Uganda; 3) investigate how social support can buffer the effects of co-occurring conditions of depression and drug use among PLHIV in urban United States. Methods: Aim 1 and Aim 2 used the 6-month follow-up data (n=480) from a cluster-randomized controlled trial that compared the efficacy of an enhanced linkage to HIV care intervention among PLHIV in rural Uganda. Aim 3 utilized the baseline data (n=1082) of a multisite US intervention to support employment and housing of PLHIV. Results: In Aim 1, psychometric assessment of the MOS-HIV subscale did not support unidimensionality and the use of sum scores. Then, physical and mental HRQOL index scores was measured using factor coefficients based on graded response models. Aim 2 findings highlight the importance of disaggregated dimensional measures revealing unique associations between social support dimensions and HRQOL indexes; instrumental social support was significantly associated with both physical and mental HRQOL, although the associations were masked for the aggregated overall social support measure. Further examination of these associations revealed that age and gender moderated the association between emotional social support and mental HRQOL indexes. Aim 3 findings showed that, in comparison to those with no depression and drug use, those with co-occurring conditions and depression were significantly more likely to have lower mental and physical HRQOL, but those with drug use exhibited no significant relationship with HRQOL. Conclusions: Our results highlight the importance of monitoring HRQOL among PLHIV using updated measurement tools and provide insights into how specific social support dimensions can be meaningful to target the unique needs of PLHIV sub-populations as they relate to age, gender, and co-occurring conditions.